Provider Demographics
NPI:1104214246
Name:KEEN, DAVID S (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:KEEN
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N CAMDEN DR
Mailing Address - Street 2:700
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4532
Mailing Address - Country:US
Mailing Address - Phone:310-550-6233
Mailing Address - Fax:
Practice Address - Street 1:414 N CAMDEN DR
Practice Address - Street 2:700
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4532
Practice Address - Country:US
Practice Address - Phone:310-550-6233
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47377122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist